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Abstract

Objectives & Background Fractures account for 25% of all injuries during childhood in the UK. Of those the radius/ulna are common (30%) −80% of those are torus fractures. Despite their innocuous nature, they are often managed incorrectly. There is evidence showing that optimal treatment entails the use of a Futuro splint for 3 weeks, with minimal followup and adequate safety netting. Many emergency departments (ED) are adopting this approach successfully.

The aim of this quality improvement project was to introduce a new pathway for the management of torus fractures, including a “virtual” fracture clinic in collaboration with our orthopaedic colleagues. We reviewed our current management and compared its costs against the new protocol, including attendance, plasters and splints.

Methods A list of children aged 0–16 years with wrist xrays between June–November 2015 was obtained. Those with a torus fracture were reviewed for method of immobilization and outcome of fracture clinic followup.

Results 24 children fulfilled the inclusion criteria; 14 were treated with a Futuro splint; 10 with a plaster of Paris (POP). All were reviewed in fracture clinic. 7 children switched from a Futuro to a POP, 3 switched from a POP to a Futuro, leaving 9 in total with a splint. 1 child was discharged from fracture clinic on first attendance; 23 required ongoing followup with at least one additional visit to clinic. This equates to at least 57 hospital appointments in this group for inclusion to the virtual clinic over 5 months. In this clinic, the Orthopaedic Consultant reviews the case notes and images; contacts the family by phone and decides whether a followup hospital attendance is required. The costs of running this would be approximately 20% cheaper on our current overheads.

Conclusion The majority of children were managed correctly within the ED. Some discrepancies were identified with preferential use of a POP in Fracture Clinic. Therefore, we educated staff on gold standard treatment through a new clinical guideline. The number of unnecessary followup attendances in this patient cohort has prompted the introduction of a virtual fracture clinic. This should generate significant cost savings as well as providing families with continuity of care, reassurance and convenience. In the future, we will reaudit whether this happens in view of expanding it to include other minor fractures.⇓⇓⇓

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